A 5wk breast fed baby whose birth weight was 3.5kg and is now 4.5kg is thriving well but is deeply jaundiced. What is the most likely dx?
a. Galactosemia
b. Breast milk jaundice
c. Thalassemia
d. Sickle cell disease
e. Congenital storage disorder
Answer: B
This question can be answered by logic, the child is thriving well and has a good weight. It is therefore very unlikely to be a pathological jaundice.
n.b.
Breastfeeding Jaundice
• common; due to a lack of milk production > dehydration > exaggerated physiologic jaundice
Breast Milk Jaundice
• 1 per 200 breastfed infants
• glucuronyl transferase inhibitor found in breast milk
• benign course
<24 h
ALWAYS PATHOLOGIC
Hemolytic
Rh or ABO incompatibility
Sepsis
Congenital infection (TORCH)
Severe bruising/hemorrhage
24-72 h
Physiologic, polycythemia
Dehydration (breastfeeding jaundice)
Hemolysis
G6PD deficiency
Pyruvate kinase deficiency
Spherocytosis
Bruising, hemorrhage,
hematoma
Sepsis/congenital infection
72-96 h
Physiologic ± breastfeeding
Sepsis
Prolonged (>1 wk)
Breast milk jaundice
Prolonged physiologic jaundice in preterm
Hypothyroidism
Neonatal hepatitis
Conjugation dysfunction
e.g. Gilbert syndrome, Crigler-Najjar syndrome
Inborn errors of metabolism
e.g. galactosemia
Biliary tract obstruction
e.g. biliary atresia
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